'By the time the pregnant woman arrived at the nearest hospital with a maternity ward—90 minutes after leaving her home in Winfield, Ala.—she was ready to deliver her baby. She made it just in time, recalls Dan Avery, an obstetrician–gynecologist who tended to patients in rural Alabama and elsewhere until his recent retirement. Too often, he says, patients are not so lucky. Some have ended up delivering on the side of the road.'

In 1980, 45 of Alabama’s 54 rural counties had hospitals providing obstetrical services. Today only 16 of them offer such care, and doctors say that means many, many women need to drive an hour or more to deliver their babies or even get basic prenatal care from an ob–gyn. Too many women cannot make such a long monthly trek, so they simply do without. Others seek care from their family physicians.

Such extreme access problems lead to difficult decisions. Some women in Alabama preemptively choose caesarean section births because they fear they will not make it to the hospital in time.

Maternal mortality is also significantly higher in rural areas.

Telemedicine—offering online video call access to patients—for prenatal care could also be part of the solution, rural health experts say. But a lack of broadband internet access continues to keep that from becoming a reality in many rural areas in Alabama, says Hillary Beard, a legislative assistant for Rep. Terri Sewell (D–Ala.)'